Tung-Liang Lin

Background/Objectives: Plantar fasciitis and Achilles tendinopathy are clinically linked conditions that share numerous biomechanical predispositions; however, the sonographic morphological correlations between the plantar fascia (PF) and Achilles tendon (AT) remain underutilized in routine diagnostic algorithms. The primary objective of this study was to investigate the concurrent relationship between the ultrasound morphometrics of the PF and AT in patients with plantar fasciitis. The secondary objective was an exploratory assessment to evaluate whether AT measurements can serve as an auxiliary diagnostic tool. Methods: A cross-sectional diagnostic study was conducted, evaluating 45 adults with clinically and ultrasonographically confirmed unilateral plantar fasciitis. The evaluation encompassed 45 affected feet and 45 contralateral unaffected control feet (internal controls). The main outcome measures included ultrasonographic PF thickness, AT thickness, and AT width. Statistical evaluations utilized the Wilcoxon signed-rank test for paired comparisons, Spearman correlations, Generalized Estimating Equations (GEE) multivariable logistic regression to account for paired-limb data clustering, and receiver operating characteristic (ROC) curves. Results: AT thickness and width correlated moderately, yet significantly, with PF thickness (r_s = 0.49 and 0.59, p < 0.001). ROC analysis demonstrated that an AT thickness >0.43 cm achieved 86.0% sensitivity, 48.1% specificity, and an area under the curve (AUC) of 0.71. Furthermore, an AT width >1.48 cm yielded 85.2% specificity and an 88.9% positive predictive value. GEE multivariable logistic regression adjusted for age and gender and accounting for within-subject clustering revealed that an AT thickness >0.43 cm was significantly associated with a 6.99-fold increase in the odds of having concurrent plantar fasciitis (Adjusted OR 6.99, 95% CI: 2.05–23.89, p = 0.002). Conclusions: Ultrasonic AT thickness and width exhibit a moderate, significant morphological association with PF thickness. An AT thickness >0.43 cm serves as a valuable supplementary diagnostic indicator associated with plantar fasciitis, underscoring the clinical importance of evaluating the entire enthesis complex concurrently.

Vascular impairment is a crucial factor associated with chronic muscle pain, but relevant research from the microcirculatory aspect is lacking. Here, we investigated the differences in neck muscle microcirculation detected through laser-doppler flowmetry (LDF) and cervical biomechanics by a videofluoroscopic image in asymptomatic participants and patients with postural neck and shoulder pain. To understand the mechanism behind the effect of myofascial treatment, transverse friction massage (TFM) was applied and the immediate effects of muscular intervention on microcirculation were monitored. In total, 16 asymptomatic participants and 22 patients (mean age = 26.3 ± 2.4 and 25.4 ± 3.2 years, respectively) were recruited. Their neck muscle microcirculation and spinal image sequence were assessed. The differences in the baseline blood flow between the asymptomatic and patient groups were nonsignificant. However, the standard deviations in the measurements of the upper trapezius muscle in the patients were significantly larger (p < 0.05). Regarding the TFM-induced responses of skin microcirculation, the blood flow ratio was significantly higher in the patients than in the asymptomatic participants (p < 0.05). In conclusion, postintervention hyperemia determined through noninvasive LDF may be an indicator for the understanding of the mechanism underlying massage therapies and the design of interventions for postural pain.

Background: Removable plug insoles appear to be beneficial for patients with diabetic neuropathic feet to offload local plantar pressure. However, quantitative evidence of pressure reduction by means of plug removal is limited. The value of additional insole accessories, such as arch additions, has not been tested. The purpose of this study was to evaluate the effect of removing plugs from foam based insoles, and subsequently adding extra arch support, on plantar pressures.Methods: In‐shoe plantar pressure measurements were performed on 26 patients with diabetic neuropathic feet at a baseline condition, in order to identify the forefoot region with the highest mean peak pressure (MPP). This was defined as the region of interest (ROI) for plug removal.The primary outcome was measurement of MPP using the pedar® system in the baseline and another three insole conditions (pre‐plug removal, post‐plug removal, and post‐plug removal plus arch support).Results: Among the 26 ROIs, a significant reduction in MPP (32.3%, P<0.001) was found after removing the insole plugs. With an arch support added, the pressure was further reduced (9.5%, P<0.001). There were no significant differences in MPP at non‐ROIs between pre‐ and post‐plug removal conditions.Conclusions: These findings suggest that forefoot plantar pressure can be reduced by removing plugs and adding arch support to foam‐based insoles. This style of insole may therefore be clinically useful in managing patients with diabetic peripheral neuropathy.